Secondary Malignancies

One of the complications of treatment is the development of therapy-related leukemias, which are frequently resistant to treatment. Therapy-related leukemias are predominantly associated with chemotherapy. DNA topoisomerase inhibitors and alkylating agents such as eptoposide and cisplatin produce leukemias with an onset of 2 to 7 years. The risk of developing leukemia from chemotherapy is most often dose-related (Kaufman & Chang, 2007). However, research has demonstrated that the benefits of chemotherapy outweigh the risks of developing secondary or long term malignancies (Kollmannsberger, Kuzcyk, Mayer, Hartmann, Kanz, & Bokemeyer, 1999).

Testicular cancer survivors also have an increased risk of developing secondary primary non-germ cell malignancies. The risk is higher than the general population (at an incidence of 1.38%) for developing lung cancer, biliary cancer, gastrointestinal cancer, bladder cancer, stomach cancer, and sarcoma (Kaufman et al., 2007). According to research, radiation and chemotherapy increases the risk of developing secondary malignancies similar to the risks of developing malignancies related to smoking (Van Den Belt-Dusebout, De Wit, Gietema, Horenblas, Louwman, Ribot, et al., 2007).

Cardiotoxicity

Although the mechanism is unknown, a long term complication for long term survivors of testicular cancer is cardiovascular disease. This is a complication most related to chemotherapy, particularly alkylating agents such as cisplatin and bleomycin. Patients who have received either cisplatin or bleomycin are at a two-fold increased risk of developing cardiovascular disease (Kaufman et al., 2007). Research has also demonstrated that platinum based chemotherapy has been found to be associated with higher risks of high blood pressure, high cholesterol levels, and coronary artery disease (Oh, Baum, Pham, Cox, Nguyen, Ensor, et al., 2007). These risks are also dose-related and are associated with high-dose chemotherapy.

Body and Self Image

Orchiectomy (removal of a testicle) can result in impairments in body image and self perception. This is usually a short term complication, as most men regain normal body image within the first year following treatment (Kaufman et al, 2007). The insertion of a testicular prosthesis is an available option and should be considered following an orchiectomy. Possible complications of a testicular prosthesis include pain, infection, and lymphadenopathy (swollen lymph nodes). Please seek medical advice from your physician.

Sexual Dysfunction

Another complication of the treatment of testicular cancer is sexual dysfunction. These impairments are often related to high-dose chemotherapy or radiation and include erectile dysfunction, inability to ejaculate, or loss of sexual desire. The highest incidence of sexual dysfunction develops within the first 6 months following treatment. Most patients recover within the next 3 years (Heidenreich & Hofmann, 1999). This complication affects quality of life and counseling is highly recommended. Please seek medical advice from your physician.

Infertility

Research has demonstrated that most patients retain their fertility when managed by orchiectomy (removal of the affected testicle) alone (Huddart, Norman, Moynihan, Horwich, Parker, Nicholls, et al., 2005). However, the risk of infertility increases with additional treatments in particular chemotherapy and radiation therapy. This risk is dose-dependent and recovery of gonadal function can take up to 5 years (Petersen, Giwercman, Skkebaek, & Rorth, 1998). Cryopreservation (freezing of semen/sperm) should be discussed and offered for all men receiving treatment for testicular cancer. Please seek medical advice from your physician.

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